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Comment
. 2020 Dec:196:375-378.
doi: 10.1016/j.thromres.2020.09.030. Epub 2020 Sep 23.

Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia

Andrew Hsu  1 , Yuchen Liu  2 , Adam S Zayac  3 , Adam J Olszewski  3 , John L Reagan  3
Affiliations
Comment

Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia

Andrew Hsu et al. Thromb Res. 2020 Dec.

Abstract

Background: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophylactic anticoagulation demonstrated improved survival, leading to the adoption of prophylactic and therapeutic anticoagulation guided by D-dimer levels. The clinical usefulness of D-dimer values, trends, and more intensive anticoagulation remains an area of clinical interest.

Objectives: Assess the outcomes and laboratory trends in COVID-19 patients stratified by intensity of anticoagulation at time of admission.

Patients and methods: Retrospectively review the differences in clinical outcomes and laboratory trends in patients hospitalized with COVID-19 in the Lifespan Health System.

Results: Between 27 February and 24 April 2020, 468 patients were hospitalized. Initial use of high-intensity thromboprophylaxis was associated with improved 30-day mortality (adjusted RR 0.26; 95% confidence interval [CI], 0.07-0.97; p = 0.045) without a significant increased rate of bleeding (p = 0.11). In severe COVID-19, D-dimer significantly increased during hospitalization with standard thromboprophylaxis (p < 0.001) but remained stable or decreased with high-intensity prophylaxis or therapeutic anticoagulation.

Conclusion: Patients who received high-intensity prophylactic anticoagulation had a downtrend in D-dimer levels and improved 30-day mortality. This suggests a role in anticoagulation in mitigating adverse outcomes associated with COVID-19; however, further randomized, prospective studies are needed.

Keywords: Anticoagulation; COVID-19; COVID-19 coagulopathy; D-dimer; SARS-CoV-2.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
(A) D-dimer values on admission (day 0), day 4, and day 8 of hospital admission among patients with COVID-19 infection, stratified by type of anticoagulation received; p-values for trends were obtained from univariate log-gamma models accounting for within-patient correlation; lines show linearized trends fit on a logarithmic scale; (B) trends in the subgroup with severe COVID-19; (C) trends in the subgroup with non-severe COVID-19.
See this image and copyright information in PMC

Comment on

  • Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
    Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Huang C, et al. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24. Lancet. 2020. PMID: 31986264 Free PMC article.

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